Babeh Edi

Shoulder Glenohumeral joint

Indications for imaging Trauma - dislocations, fractures, tendon calcifications Arthritis survey Anatomy  Demonstrated Glenohumeral joint Shoulder Rt AP Anatomy Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London   Basic Patient Position The patient stands erect AP median saggital plane 90 degrees to the film coronal plane parallel to the film, the patient is then rotated 35 to 45 degrees to the affected side until the dorsal surface of the scapula is parallel to the film. The arm is placed in normal  anatomical position palm forwards with the distal humeral epicondyles equidistant from the film, with slight (15 degree) abduction. Take care to prevent the patient leaning backwards and hunching up the shoulder. Projections may be made in a variety of internal and external rotations to evaluate rotator cuff calcifications. Shoulder Rt Joint Projection Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London   Radiation protection Direct lead rubber gonad protection using a "half apron". Avoid irradiating the thyroid and breast tissue as much as possible. Central Ray The horizontal central ray is direct to palpable glenohumeral joint. Exposure is made on suspended expiration. Exposure Factors Kv mAS FFD (cm) Grid Focus AEC Cassette 80 8 100 No Fine No 18x24 cm 85 12 100 Yes Fine Yes 18x24 cm Thickset patients may require the use  of a grid Evaluation of the Image ID and markers must be present and correct in the appropriate area of the film. Limits of the examination, superiorly the skin surface above the clavicle, medially the lateral one third of the clavicle, laterally the skin margin of the humerus. Evidence of collimation on four sides equally around the centering point The glenohumeral joint space must be visualised with the joint surfaces separated. The greater tubercle of the head of the humerus should be seen in profile. There must be adequate penetration of the area around the coracoid process and the contrast should be low enough to visualise the soft tissues around the head of the humus. Shoulder Glenohumeral Joint Lt Radiograph Related Projections Shoulder joint Survey Supero-inferior Modified AxialP Scapula lateral Clavicle PA Acromio-clavicular joint AP Additional modalities MRI  (replaces arthrography)  for the joint structures CT RNI evaluation of metastases